Summary version of our Case for Change (published July 2021)

Our five critical challenges

To play its part in improving healthcare and health outcomes, the New Hospitals Programme must address five critical challenges:

  1. Demographic trends and access
  2. Ageing acute estate
  3. Specific hospital site-related problems
  4. Keeping up with the best in the world
  5. Playing a full part in rebuilding our regional economy

1. Demographic trends and access

  • We provide health services to a population of 1.8m people across diverse communities and varied geographies.
  • Access to services and travel pose a significant challenge: towns and cities are widely spread and our region’s geography adds to expected travel times.
  • Our population is ageing: the number of people over 65 is projected to increase by 22% by 2030.
  • More people in our region experience mental and physical ill-health than in the rest of England.
  • We also face deep socioeconomic challenges: 20% of our population lives in the 10% most deprived communities in the country.
  • All of these factors will increase demand for health services both in and out of hospitals in the future.

2. Ageing acute estate

  • The age, design and condition of some our hospital buildings mean they do not comply with many basic standards, restricting our ambition to provide high-quality, safe, efficient and cost-effective services for our communities.
birds eye view picture of the royal lancaster infirmary site
Royal Lancaster Infirmary
  • The condition of Royal Lancaster Infirmary (University Hospitals of Morecambe Bay NHS Foundation Trust) and Royal Preston Hospital (Lancashire Teaching Hospitals NHS Foundation Trust) has reached a critical stage. Without investment, buildings and services could fail, increasing our patients’ deepening health inequalities and increasing the burden of ill-health on our population.
Birds eye view picture of Royal Preston Hospital
Royal Preston Hospital


  • Any adverse impact on services due to the quality of the estate at Furness General Hospital (University Hospitals of Morecambe Bay NHS Foundation Trust) would have a deeper impact due to its remote location.
Birds eye view picture of Furness General Hospital estate
Furness General Hospital


  • The poor condition of our hospitals also means we cannot recruit and retain the number of staff we need to deliver services.

3. Specific hospital site-related problems

Royal Preston Hospital (RPH)

Picture of two men stood in a corridor
Two men stood in a corridor
  • Serious dilapidation of buildings due to decades of underinvestment, and backlog maintenance costs totalling £157m.
  • Demand exceeds capacity across all clinical areas: outdated buildings lack flexible capacity, leading to congestion and overcrowding so that patients wait longer than is acceptable for all aspects of care.
  • Non-compliance with Health Building Notes (HBN): only 19% of rooms are single-person (should be 50%) and operating theatre capacity is 40% below requirements. This makes it challenging to implement safe infection control measures and to meet the privacy and dignity standards we expect for our patients.
  • The distance between clinical departments makes the hospital experience worse for patients and carers.
  • Some tertiary (highly specialised) services have developed and expanded without being able to meet all the estate requirements, restricting our ability to offer some specialised services that should be available to our population.

Royal Lancaster Infirmary (RLI)

Picture of steep hill outside Royal Lancaster Infirmary
Steep hill outside Royal Lancaster Infirmary

Most of the site is located on a slope, which in some areas is too steep for patients to be safely moved except by ambulance. Access to much of the site is challenging for people with a disability.

  • Backlog maintenance costs totalling £88m, predominantly due to the condition of the estate. Running costs are double that of a new build at £442 per square metre due to the age of the site.
  • The estate fails to meet many Health Building Notes (HBN) standards – single room provision is only 50% of the recommended standard capacity and less than a third of our ambition for 70% single rooms.
  • Site made up of around 20 separate buildings, some linked by long passages, with some separated from the main complex by public highways. This means staff and patients must make longer journeys than is desirable, leading to poor experiences of care, patient discomfort and significant operational inefficiencies.

Furness General Hospital (FGH)

Difficulty in accommodating the latest digital technologies and robotics needed to create an agile network of care across the region: these are essential given the remote geographic location.

  • Significant backlog maintenance, including an element of physical condition and lifecycle works. Estate running costs of £375 per square metre.
  • Site fails to meet some Health Building Notes (HBN) standards and capacity requirements, in particular in the Critical Care Unit / High Dependency Unit and single room provision.
  • Significant risk that this site may never meet carbon emission standards.

4. Keeping up with the best in the world

  • Providing state of the art hospital facilities and technology will strengthen Lancashire and South Cumbria’s position as a centre of excellence for research, education and specialised care, significantly boosting the region’s attractiveness to potential recruits and the highest calibre of clinicians.
  • We need to ensure new hospitals fully embrace the benefits of digital technologies to create an agile network of care, allowing us to optimise the size of our physical footprint and minimise environmental impact.
  • This will also enable us to provide more specialised services in our hospitals and deliver more care closer to home.
  • We want to play a leading role in tackling the key issues of our generation – cutting carbon emissions and environmental damage. Aged estate, which was built to service the needs of previous generations, is hampering our ability to achieve this.

5. Playing a full part in rebuilding our regional economy

“I want us to build brand new hospitals that are the most accessible in the world – where people can get there, get around and interact well with their surroundings however able they are.”

  • Our hospitals are some of Lancashire and South Cumbria’s most significant community assets: they are anchor institutions providing healthcare to our population and employment to around 40,000 people.
  • The New Hospitals Programme will create jobs and support the economic regeneration of our region, needed now more than ever as the global Covid-19 pandemic has disproportionately impacted those most in need.
  • Investment in hospital infrastructure will support us to build back better and help the NHS deliver on its net zero carbon ambition.

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